In an effort to hold down costs for hospitals, Orange County has promised not to “willfully” recruit more indigent patients for health care programs, according to a new contract with local hospitals.

Contracts with the new language were signed by all 21 local hospitals with emergency rooms, according to county health officials.

The new contract language is part of an effort to keep treating those who lack health insurance or the ability to pay for care and at the same time to cut the financial burden borne by the hospitals.

The word “willfully” was inserted in the contract to “reassure the hospitals that we’re not going to ramp up our [indigent] population until [new federal funding] is approved,” said Dan Castillo, administrator of the county program.

The county program, boosted by state and federal funds, offers the medically indigent a health program beyond emergency care. But if too many enroll, the hospitals don’t get reimbursed. Orange County, unlike many other counties, doesn’t have a county hospital to care for its indigent patients.

Castillo said an estimated 35,000 medically indigent adult, legal residents of Orange County, age 21 to 64, currently are enrolled in the program. He estimated another 105,000 lack health insurance and meet the financial criteria but aren’t facing a health crisis that would bring them immediate care.

Record numbers of indigent adults have been arriving in local hospitals in the past three years due to high unemployment and the poor economy, according to hospital officials.

County outreach efforts to the indigent exceeded the amount of money available to pay doctors and hospitals for their care, said Julie Puentes, regional vice president for the Hospital Association of Southern California. “That’s why, ultimately, the doctors and the hospitals asked them [the county] to stop.”

She said county administrators offered the word “willfully” for the new contract.

County supervisors over the summer agreed there is a problem with the program for indigent patients but said the county didn’t have the money to fully reimburse the hospitals.

In August, hospital officials estimated their increased costs at about $100 million and predicted all county residents ultimately would pick up the tab in the form of higher health care costs.

The new contracts said the county “shall not willfully and intentionally expand the enrollment of persons” into the indigent program until it is certain funds will be available to pay for their care.

The limitations don’t apply to emergency care. Anyone with an emergency medical problem can go to an emergency room and receive treatment.


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